Wednesday, October 28, 2009

Amazing Visual Memory!

Here is a video from the CBS Early Show on an artist with autism who has a photographic memory for architecture. This is true talent. (PS - Have to mention this: be sure to check out his pencil grasp. Just goes to show you that as long as the grasp works for you leave it alone).

Watch CBS News Videos Online

Financial Aid for Occupational Therapists

Here is an informative post that was suggested to share - it is a large collection of fellowships and scholarships for people who want to study occupational therapy. The post can be found at

New Option for Augmentative Communication

Came across this new tool for augmentative communication called Tap2Talk. Seems like a nice alternative for augmentative communication. Watch the video for how it works. The positive features are: the price point, no Internet access is required, cool age appropriate tool and you can put in your own pictures and voice. One negative is that you do need sufficient fine motor skills to utilize a Nintendo DS. Perhaps you could adapt a stylus though. Any comments or thoughts?

Tuesday, October 27, 2009

Handwriting Standards

Here is an interesting and informative website for any therapists who work on handwriting skills. Handwriting without Tears has created a website on handwriting standards. It includes a document with handwriting standards by grade level. In addition, you can look up standards by your state as well. There is also some (not much) research quoted to support teaching handwriting skills. The website is entitled HandwritingStandards.  

Monday, October 26, 2009

Upper Extremity Activity in Children with Cerebral Palsy

Developmental Medicine & Child Neurology published research on 23 children (age range 8-18 years old) with cerebral palsy (21 hemiplegia and 2 spastic diplegia). The purpose of the study was to determine a relationship between muscle strength, tone and range of motion and functional hand skills. The results indicated that active supination range, strength and force were strongly related to limitations in hand activity. Further research was recommended to determine cause and effect in these limitations.

Reference: SIRI M BRÆNDVIK, ANN-KRISTIN G ELVRUM, BEATRIX VEREIJKEN, KARIN ROELEVELD. (2009) Relationship between neuromuscular body functions and upper extremity activity in children with cerebral palsy Developmental Medicine & Child Neurology Published Online: 7 Oct 2009 DOI 10.1111/j.1469-8749.2009.03490.x

Teaching Motor Skills to Children with Cerebral Palsy and Other Movement Disorders

Friday, October 23, 2009

Great Activity Idea for Fine Motor Skill Development - Fingarings

I just finished reading about this creative activity idea in the current issue of Advance for OT's. The article, written by Cumba Siegler OTR/L, explains how to create "fingarings" out of Sculpty clay. She describes how to create rings for the fingers out of clay. She then offers several activity suggestions for the "fingarings". This is such a fun, simple and useful activity. Definitely worth a read! You can read the full article at Advance for OT's.

Here are some more suggestions to add to the authors ideas if you make some "fingarings".
1. Tie a string between the ring and a pencil. Holding the pencil with one hand can you flip the ring onto the pencil?
2. Put them on a child's toes - can a child cross midline, flex and grab a ring?
3. Hide them in the sensory table.
4. Lace them on shoelaces or pipe cleaners.
5. Make smaller ones to increase difficulty of the lacing.
6. Try to put scarves or materials through the rings (the resistance from pulling through is a nice proprioceptive warm up)

Any one want to add to the list?

Thursday, October 22, 2009

Environmental Changes to Physical Spaces in Schools

A researcher from NJIT, Architect B. Lynn Hutchings, offers suggestions for schools to make changes to the physical lay out of buildings to accommodate for students with disabilities. Some of her suggestions are:

1. Inter-disperse related services such as speech, occupational and physical therapy throughout the school

2. Auditoriums should have ramped aisles and stages.

3. Use color coded hallways and easy to read signs.

4. Create rules for hallway traffic - i.e. stay to right

5. Book cases and materials at accessible heights for all.

6. Have storage areas for large equipment such as standing frames or gait trainers.

These are all great suggestions and some may be on your wish list. What other simple suggestions can you recommend that work in your school buildings to improve accessibility?

Reference: Improving Schools for Disabled Students is NJIT Researcher's Mission. Retrieved from the web on 10/22/09 at

Wednesday, October 21, 2009

Robots and Writing

Found out about this great article on writing and robots from @Pediastaff on Twitter. A young boy with dyspraxia has been testing a robotic arm to imnprove his visual motor skills. Read this story from the BBC News

Tuesday, October 20, 2009

Children with Cold Hands and Feet

Here is something to consider when working with children who have neurological disorders. A recent thesis study revealed that children in wheelchairs with neurological disorders have different skin temperatures than in children without neurological disorders. The study showed that in children with neurological disorders the temperature of the feet was three degrees colder and the hands were two degrees colder. In addition, the children with the colder extremities also exhibited difficulties with constipation, sleeping and pain. The author comments on additional problems with balance when the feet are cold.

This press release was very interesting to me. Based on my own experiences, when my hands and feet are cold it can make me very distracted. The sensory input and message to my brain will sometimes overpower my focus or concentration on an activity. I will incessantly complain that "I am freezing, my toes are going to fall off, I can not feel my fingers, blah, blah, blah". With colds hands it is very difficult to manipulate items. I have seen myself shaking from the cold hands and being unable to put a key in to start a car. And I have an intact sensory system.

Now think of children with compromised sensory systems. This is one more aspect of the human body to explore when observing and evaluating function in children. How are fine motor and gross motor skills effected by changes in the temperature of the extremities of the body? How can we help children with this information? It would be very interesting to test how changes in skin temperature effects motor skills and attention skills... Anyone up for some research?

Reference: Eureka Alert Brain-damaged Children Often Hanve Cold Feet. Retreived from the web on 10/20/09 at

5 Ways to Develop A Personal Learning Network for Pediatric OT/PTs

Pediatric occupational and physical therapists frequently practice independently within the schools and clinics. Unless you work for a large school district or children's hospital, therapists can feel very alone when it comes to having a personal learning community around them. Sure therapists interact with children, parents and teachers but sometimes finding other therapists to bounce ideas off of or get advice from can be hard to come by. If you are a therapist who works independently or even within a large group of other pediatric therapists it is important to build a personal learning network (PLN). This can include of variety of people, resources and mentors.

Here are 5 ways to develop your own PLN:

Find a mentor - Nothing is better than having a mentor to ask questions, discuss a particular client's needs and treatment strategies. When you work alone though this is not always a possibility. One idea is to hire someone to consult with you. You could pay an experienced therapist an hourly wage to answer your questions and provide you with guidance. You could ask the therapist to write up a contract describing the consultation services as a ongoing continuing education course. Ask your employer if they would be willing to reimburse you for the course.

Make contacts at continuing education courses - When you attend professional development courses you are able to network with other therapists that share the same interests that you do. Get email and phone numbers from other professionals so that you can keep in touch after the course to go over different topics.

Follow blogs - There is a large amount of information in the blogosphere. You can keep track of what is posted on blogs that pertain to pediatric therapy in Google Reader. Just click on the RSS feed buttons of the blogs and that will allow you to follow the content in one location. Finding the right blogs can be a slow process. Start out here - you can see many OT blogs at on Alltop at the occupational therapy page. For physical therapy check out the Alltop physical therapy page.

Follow Tweets - Twitter can provide you will up to date information on many topics especially assistive technology. There are many experienced professionals on Twitter, who tweet about new technologies on the market or special deals. You can also follow @APTAtweets, @AOTAInc, @YTherapySource and more all on Twitter to get up to date information on research, policy, news stories and more. For more info on Twitter see my previous post entitled Twitter for Therapists.

Join a listserv - There are several listservs sponsored by the APTA and the AOTA. Join the pediatric listservs to see what other therapists are talking about. You can also post all your own questions on the listserv to have other therapists answer.

Anyone want to add any other suggestions on how to build your own personal learning network?

Saturday, October 17, 2009

Fine Motor Toy Winners to Add to Your Wish Lists!

Every year Family Fun magazine publishes an issue with their Toys of the Year. This year there was a large collection of toys that encourage fine motor skill development and handwriting skills. You can view the top 10 Toys of the Year at Family Fun.
Here were some of the fine motor winners for this year:

Build It Bigger - manipulate chunky nuts and bolts

Pool Sharks - use the trigger action dolphins to hit pool balls

Color Me A Song - drawing to music. The music is based on how fast or slow you draw

Scribble and Write - follow the step by step guides to create letters and shapes on the electronic board

Burger Builder - new Play Doh set that allows you to press, mold and create burgers.

Here is a fine motor winner from last year:

Rondo Vario - dress the caterpillars by lacing on the correct color and shape.

Maybe you can add these items to your wish lists to add to your therapy bags. Does anyone have any experience or opinions on these new games?

Fine Motor Activity: Make Your Own Ink Dabber

Children love to use ink dabber markers. This is a great way to encourage visual motor skill development. But, ink dabber markers can be very expensive. Here is a simple way to make your own ink dabbers including using different types of handles. To order the letter dot worksheets visit Your Therapy Source's DOT Letters and Shapes.

Friday, October 16, 2009

More Yoga for Children Resources

Previously, I had done a post on Yoga for children. I have since come across two additional resources that may be of interest to pediatric occupational and physical therapists who work in the schools.

One is Yoga in my School. This website has all the steps you need to do to bring Yoga into the schools. It is loaded with information on different poses and the benefits of yoga for children and teens. I am hoping to get a chance to explore it further.

The other resource - Teaching Kids Yoga. Again, this site is jam packed with great information on yoga for children. There is activity ideas, meditations, song suggestions and more.

Would love to hear from therapists who have had success using yoga in the school environment.

Thursday, October 15, 2009

KEEN - Kids Enjoy Exercise Now

I just learned about this organization on Twitter today and wanted to share the information. KEEN - Kids Enjoy Exercise Now is a non profit organization in 8 cities in the USA and three cities in the United Kingdom. As described on the website:
"KEEN is a national, nonprofit volunteer-led organization that provides one-to-one recreational opportunities for children and young adults with developmental and physical disabilities at no cost to their families and caregivers. KEEN's mission is to foster the self-esteem, confidence, skills and talents of its athletes through non-competitive activities, allowing young people facing even the most significant challenges to meet their individual goals".

This seems like an excellent opportunity for children, their families and the volunteers. I wish it was in my area - I would definitely volunteer! Has anyone had any experiences with this organization? Would love to hear about it.

Costumes May Do The Trick

Children love to dress up from an early age. Boys or girls enjoy the fun of pretending to be someone else. Pediatric therapists are always looking for innovative and creative ways to incorporate movement tasks into everyday play. Since Halloween is coming upon us, perhaps dressing up will do the trick. Here are several reasons why to include dressing up into a therapy session or suggestion for an at home activity.

1. Functional Tasks: Of course, an occupational therapist looks at dressing as a very functional task. Children will be motivated to practice buttoning, zippers or other fasteners in order to get the costume on. They have to put arms into sleeves and legs into pants. This is much more fun that getting dressed in the morning.

2. Fine Motor Skill Practice: In order to fasten the clothes, children need to use their fingers and hands.

3. Balance skills: When a child is stepping into a costume, they must balance on one foot to get the other foot in.

4. Imagination and Free Play: In today's fast paced society, children do not have extensive amounts of free time to just play. When a child puts on a costume it opens up a entire new world of their imagination.

5. Gross Motor Skills: Once that costume is on, a child can not resist to leap over tall buildings, gallop on a horse, be in a circus, fly on a broom...
The list goes on and on. Children will rarely sit still while in costume.

So the next time you want a child to practice fine motor skills, balance and gross motor skills all while doing a functional task - get out a box of dress up clothes or costumes!

Wednesday, October 14, 2009

Fine Motor and Tactile Input Activity

Here is a new activity idea called Hunt and Find. This inexpensive activity can be created with objects from around the house or the therapy room. To view the directions on how to create and play the activity click on Hunt and Find. For more activities like this check out $ensory Motor Fun on a Budget.

Monday, October 12, 2009

Collecting Data in the School District, Clinic or Home

School based occupational and physical therapists are responsible to track a student's progress with regards to the goals that pertain to their area of expertise. This is done my daily notes, monthly progress reports and annual reviews. Goals are created by the IEP team and in some cases by the therapists themselves depending upon the school district. The goals that are created are measurable. The same holds true in the clinic and home - there should be goals that are measurable.

What about when it comes to modifications or interventions that a therapist recommends? These suggestions should be measured to determine whether they are effective or not. One way that this could be done is using Google Docs. You can use Google Docs to create data collection charts for free. You can then have the school staff or the therapist record the data regarding the outcomes. Here is an example of a form created using Google Docs to measure the effectiveness of physical activity breaks during the school day for a specific student. Once the form is completed the data is collected in a spreadsheet which looks like this.

This form was created as an example to track whether physical activity breaks are effecting the student's academic success. This could be done with many other modifications to get more specific data collection. In my opinion, this is a great tool to track sensory diets that are in place for a student. Depending upon the students that you work with you could track the use and outcomes of weighted vests, sitting on therapy ball in class, preferential seating, compression garments and more.

Maybe track when the best time would be for a student to use different types of adaptive equipment. For example, try using a standing frame at different times of the day or during different classes to determine the best time to utilize the equipment to effect the child's education.

Need ideas for physical activity breaks? Check out Mini Movement Breaks.
Create your own form to track the benefits of the physical activity breaks like this form.

Sunday, October 11, 2009

Adapted Musical Instruments

I have recently come across several interesting websites regarding adapting musical instruments. School based occupational and physical therapists are frequently adapting tools in the classroom. Here are several websites for suggested adaptations:

One Handed Woodwind Instruments

A Day's Work - This is a commercial website of items for sale. Although you can get some great ideas from the pictures of how you could adapt some instruments yourself.

Adaptive Music Wiki

Choosing a Musical Instrument

Curious to know how many of you get involved in the music room?

Wednesday, October 7, 2009

Homemade Assistive Devices

Workshop Solutions is jammed packed with information about homemade assistive devices for people with disabilities which I heard about from Barbara Boucher website Therextras. There is a full list of mobility and communication devices that two men have compiled. There are many photos to support the text which describes various pieces of mostly homemade equipment. Some of the photos and ideas are a little dated but the creativity and ingenuity is fun to view.

I did not look at every one but here are some of my unique favorites:

1. Toilet table - a table to encourage a child to sit on the toilet for longer.

2. Quick Knickers - adapted underwear

3. Swingboard - homemade platform swing

4. Customized walker - homemade tiny gait trainer

5. Mini wheelchair - great retro photos.

Make sure you have ample time to explore this website if you are interested in adapting equipment.

OT Home Programs Make a Difference!

I was so excited to find this recent research. Finally, some strong statistics supporting that occupational therapy home programs make a significant difference in a child's life. Pediatrics published research on children with cerebral palsy who received occupational therapy home programs. There was 36 children in the study (mean age of 7.7 years old) with gross motor classification levels I through V. Eighty five percent of the children exhibited spasticity, 14% dyskinesia and 3% with ataxia. A double blind, randomized controlled study was done comparing groups of children who received 8 weeks of an OT home program and a control group. At the end of the 8 week session, the children who participated in the OT home program exhibited statistically significant improvements in function and parent satisfaction with function. The researchers concluded that pediatricians should recommend a collaborative, evidence based OT home program which should be carried out 17.5 times per month for 16.5 minutes per session.

Reference: Novak, Iona, Cusick, Anne, Lannin, Natasha Occupational Therapy Home Programs for Cerebral Palsy: Double-Blind, Randomized, Controlled Trial Pediatrics 2009 124: e606-e614

Need activity ideas for occupational therapy home programs? Check out Therapeutic Activities for Home and School.

Tuesday, October 6, 2009

Fine Motor Pumpkin Activity

Here is a fun, simple, step by step fine motor activity that encourages tactile input and bilateral coordination as well. This is a large file so it may take a little time to download.

Monday, October 5, 2009

AFO's in Children with CP

The Journal of Bone and Joint Surgery published research on the use of a floor reaction ankle foot orthoses (AFO's) on children with cerebral palsy (CP). Using gait analysis, the researchers determined that the AFO's restricted sagittal plane motion (left to right motion)which results in improvements in knee extension. The best results were seen in children who had knee and hip flexion contractures of more than or equal to 10 degrees. The efficacy of the orthotic was limited if knee and hip flexion contractures were greater than or equal to 15 degrees. The researchers concluded that this type of orthotic should not be prescribed if knee and hip flexion contractures are great than or equal to 15 degrees.

Reference: Rogozinski, Benjamin M., Davids, Jon R., Davis, Roy B., III, Jameson, Gene G., Blackhurst, Dawn W. The Efficacy of the Floor-Reaction Ankle-Foot Orthosis in Children with Cerebral Palsy J Bone Joint Surg Am 2009 91: 2440-2447

Outdoor Field Trips with the Family for Fall

Fall happens to be one of my favorite seasons. In upstate New York it is the calm before the storm. It begins to get chilly but we also have some great outdoor activities to enjoy. Plus, we try to take advantage of any nice days before the bitter cold of the winter sets in. To those of you who follow this blog or us on Twitter, you probably have realized that in my opinion outdoor activities are a must for developing children. So here are some ideas for field trips to get outdoors this Fall.

Go apple picking. Here in upstate New York this is a tradition. To pick and eat an apple right from the tree is truly a treat. Children of all ages can usually reach the apples to pick them. If you do not have an apple orchard near you, still take advantage of the fresh fruit in the grocery store. Bring some home and have the children help you wash them, cut them up (if possible) and make applesauce. Your house will smell great after you come in from the outdoors!

Visit a corn maze. This is another great tradition in the upstate area. We have several corn mazes to choose from. You follow a path to navigate through the corn. The paths are very wide at some and it is flat terrain making some of them possibly wheelchair accessible. It is very bumpy though. Children of all ages like this activity. I have gone to corn mazes with babies through teenagers. Each child takes in the experience differently.

Visit a playground. A crisp Fall day is a great day to visit a playground. If you need to locate an accessible playground you can go to Accessible Playgrounds. If you can not find a completely accessible playground, perhaps visit one to explore other options. Maybe bring some activities that your child can use at the playground i.e. large ball, bubble machine, etc. Your child can then play with other children at the playground but perhaps not on the equipment.

Go letterboxing or geocaching. On the websites you will find listings of where boxes are hidden. For letterboxing, you follow written clues to a box. Inside the box you will find a log book and a stamp pad. You bring along a log book on your journal and stamp in the books to record that you found the box. This is great fun for all ages and abilities. Usually the clues listed on the website offer some description as to the terrain of where the clue is located. Some are located on bike paths for easy accessibility.

You need a GPS or smart phone(i.e. iphone or blackberry) to go geocaching. With geocaching, you follow directions on the navigational system to locate small boxes. Inside the small boxes are log books and sometimes trinkets. The kids can bring trinkets with them on the hunt. When they open the box, they put their trinkets inside the box and remove one to take home. Again, on the website, it gives descriptions of where the boxes are located and how easy or hard it is to find them.

For letterboxing or geocaching, all young children will need assistance. The boxes are hidden off of the path several feet. An adult usually has to locate the actual box. Based on our experience, letterboxing requires a bit more hiking whereas with geocaching the boxes are usually closer to where you park.

In our family, this is one of our favorite outdoor activities.

Go fishing. This is another one of our favorite family outings. It is so enjoyable to watch your child catch a fish for the first time or many times. The look of your child's face when they bring in a big fish is priceless. Viewing the Fall foliage is a great addition to fishing this time of year.

What is your favorite Fall field trip?

Friday, October 2, 2009

This is fun!

This is a neat tool to try out for fun or for some unique visual games for children. All you have to do is upload a photo, hit the light bulb to turn out the light and then light up the picture with the match. Great fun to encourage visual perceptual skills. Check out the one I made.

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Click here for full screen version

Assistive Tech Tip: Computer Timers

Here are some free count down timers on the computer to keep children aware of the amount of time left for an activity or lesson.

My favorite is the timer on where you can actually see the time expiring instead of just numbers counting down. You can also add music to the timer at the top of the page.

If you want a countdown timer with an alarm that sounds at the end of the time try the online stopwatch.

Lastly, if you need a timer when you are not online, you can download cool timer (I have never tried this one though).

Fine Motor Activity Idea: Mystery Painting

Here is a fun activity for children of all abilities. Add or eliminate steps depending upon the child's ability.

Step One: Write on a piece of paper in white crayon. This can be something more difficult like a mystery note to practice letter formation or try something simpler like a scribble. If necessary, have an adult or friend draw anything with the white crayon.

Step Two: Paint over the paper using watercolors. Darker colors will work best.

Step Three: Let the picture dry to reveal the mystery message or picture.

The great thing about this activity is that by varying the activity you vary the fine motor skills necessary to complete the project. This would be a fun way to send a secret message to a friend. Write the note with white crayon and send it to a friend. The friend has to paint over it to read the note. For Halloween, make a scary picture and paint over it with black and orange. HAVE FUN!

10 Things to Do To Celebrate PT Month

This years theme is "Move Forward Physical Therapy Brings Motion to Life". The focus is on how PT can help you achieve long term quality of life. Here are 10 suggestions to celebrate PT Month in a school or pediatric setting:

1. Think of an activity club that you could start at the school to promote quality of life... maybe an early morning or lunch time walking club? Another way to encourage long term quality of life is to improve posture. Perhaps plan a postural screening day with hand outs on proper posture available.

2. Host the Physical Therapy Olympics - invite school staff, parents and students to participate in the PT Olympics. Try relay races in wheelchairs, with walkers and therapy balls.

3. Create an PT Contest - For example - Who can take the most steps in a week (use pedometers)? The largest number of steps wins a PT t-shirt.

4. Create an PT Quiz - Distribute an PT quiz with many questions regarding what PT is and how it helps children. Every person who fills out the quiz gets a small prize.

5. Do an in-service on the benefits of PT to the school staff and parents.

6. Plan an PT Month Party! - Allow the kids to vote on a party theme such as gross motor, sensory or playground. Create games around that theme.

7. Volunteer for the Career Fair at the school. Educate prospective college students on what PT is.

8. Have an Adaptive Equipment and Assistive Technology Fair - demonstrate different types of equipment that PT's recommend for students to school staff and parents.

9. Hang up a large poster in the hallway about physical therapy. Print out the APTA logo.

10. If you do not have time for any of the above ideas here is the easiest - just ask to make an announcement over the loudspeaker of the school about PT month. Inform the school in a few sentences about physical therapy.

Check out our motivational section on our website for certificates, awards and signs for physical therapy.

Any one else have any ideas? Please comment.

Thursday, October 1, 2009

Do You Sugar Coat?

An article in a recent issue of Pediatrics brings up an interesting point when dealing with mothers of young children and their child's development. Three focus groups, consisting of mothers of children who received early intervention, mothers of typically developing children and specialists were studied. Most mothers indicated a "non alarmist style of communicating if delays were suspected". Some other mothers indicated that they preferred a "more direct style" so that they were better able to understand. All of the focus groups felt that the following were a priority: developmental timeline of what to expect, suggestions to encourage developmental skills and a follow up evaluation.

What do you do in your daily practice? Are you a "sugar coater or a straight talker"?

Reference: Sices, Laura, Egbert, Lucia, Mercer, Mary Beth Sugar-coaters and Straight Talkers: Communicating About Developmental Delays in Primary Care Pediatrics 2009 124: e705-e713
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